A Discussion About Testing and Treatment with Dr. Anne Hill
Dr. Michael Ruscio: Hi, everyone. Today I spoke with Dr. Anne Hill. We covered a wide range of topics in a fairly short period of time. We discussed testing for and treatment of intestinal parasites and pathogenic gram-negative bacteria. She talks about the two tests that she likes the most as well as both pharmaceutical and natural treatments.
We also snuck in a discussion on mast cell activation syndrome (MCAS), which is when someone has a very reactive system and tends to have negative reactions to supplements, foods, and even things like pollen or fragrances. Then we transitioned into what may drive that kind of hyperimmune response: Mold or mycotoxins. She discussed a very practical method of assessment and tracking of symptoms and treatments.Struggling with parasites, mold, or find that you are very reactive to food and treatment? Dr. Anne Hill discusses the best testng and treatment for these issues. Click To Tweet
She touches on the first thing we should address. Then the second and the third, and how to work through treatment options in a hierarchical way, because these things may seem overwhelming and unapproachable if we try to tackle them all at once. We discuss how to smoothly unravel this knot and navigate through what may be a very tough road of reactions.
So a great conversation with Dr. Anne Hill: Parasites, gram-negative pathogenic bacteria, mast cell activation syndrome, and micro toxicity.
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In This Episode
Episode Intro … 00:04:08
Proper Testing Can ID Parasites … 00:08:37
Do Tests Work? … 00:12:16
Our World is a Different Place … 00:14:05
Strep Infections in Kids … 00:17:36
Tests Give Clinicians a Starting Point … 00:24:34
Some Talk About Parawellness Research … 00:28:21
More Info on GI-MAP … 00:31:19
The Immune System and Mast Cells … 00:38:41
There’s More to Mold Than You Think … 00:39:06
Testing for Mold in Your Home … 00:40:56
Treating Mold Infections … 00:46:26
Episode Wrap-Up … 00:51:55
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DrMR: Hi, everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Dr. Anne Hill to discuss gram-negative bacteria and parasites in the GI tract. Welcome to the show.
Dr. Anne Hill: Thank you. Great to be here.
DrMR: It’s great to have you here. Allison C. Becker had some great things to say about you. What was interesting for me, we had this initial connecting point on parasites and gram-negative bacteria in the GI to discuss, but you also deal with histamine intolerance, or MCAS (Mast Cell Activation Syndrome), which describes people who tend to be very sensitive and very reactive. This also seems to tie into mycotoxins or mold and fungal toxins.
We’ll maybe get a brief snippet of that here at the end, but there’s a lot there to tackle. If any of the MCAS or mycotoxins weave into the conversation on parasites and gram-negative bacteria, okay. Otherwise, I’ve made a note to do a quick sidebar at the end of our chat.
DrAH: Absolutely. I’m excited to talk about that because that is big in my practice.
DrMR: Before we go any further though, tell people a little bit about you, just in case they haven’t come across your name before.
DrAH: I am a naturopathic physician and I practice in Portland, Oregon. I’ve been a naturopath for 15 years. Before, that I was an herbalist and craniosacral therapist. I’ve been doing all these things since I was in my mid-20s. I was actually considering going to medical school or getting a nurse practitioner degree and then somebody told me what a naturopath was, and I was like: “Wow, I think that’s what I need to do.”
I moved to Portland and went through school here and I’ve been a primary care practitioner offering people all these other alternative ways of looking at things and being able to do homeopathy and herbs and supplements to help with their health.
DrMR: I love it. I love it.
DrAH: My favorite thing is when people come in, and they’ve been diagnosed with conversion disorder or other psychosomatic illnesses just because nobody can figure out what’s going on with them. I love being able to help them, support them, and talk to them about what’s happening in the body. We must start looking at things differently. A lot of these issues are not really recognized in Western allopathic medicine or they don’t really know what to do with them. I always feel I’ve got a few tricks up my sleeve to help people, which is great.
DrMR: Awesome. Certainly, one of those tricks is optimizing the health of one’s gut; being able to identify parasites and other infectious or dysbiotic organisms can be very helpful. I’m assuming most people know what a parasite is; they may not know what gram-negative bacteria are. There are some things we used to think were parasitic and now they’re maybe not that bad for us. They work with us. How do you launch into, “Okay, here’s a host of either common parasites or bacteria we should be on the lookout for if someone’s ill and not responding.”
Proper Testing Can ID Parasites
DrAH: A lot of times I do comprehensive testing with people. Especially if people have had something done in more allopathic medicine. If they’ve gone to the hospital with diarrhea or with abdominal tenderness or pain or nausea or just not feeling well for a long time. Traditional medical practitioners will run an O &P (or ovum and parasite) test. This test is probably about 10 to 30 percent accurate, and that’s low for a test.
I usually talk to them about getting another test done. One of the places I recommend to people is through Parawellness Research, a lab in Colorado. It’s run by a parasitologist; he has been reading people’s fecal matter under a microscope for a long time and he really knows what he’s looking for. I also have people do a GI-MAP (Gastrointestinal Microbial Assay Plus) test. It uses PCR (polymerase chain reaction) technology that looks for DNA of a whole bunch of different gram-negative bacterial infections as well as parasitic infections.
If I refer people to one of those two labs, there’s almost always something that comes up that’s either an infection or some dysbiosis that we can treat. I don’t just randomly refer everybody to get these tests done.
Definitely, if people have issues, if they have skin issues, if they have gut issues, if they have a health history that leads me to believe that they probably have some level of dysbiosis — like, they say “I went to Mexico, and then I never felt good after that,” — then I know they’ve probably been exposed to something and I’ll refer them to get one of these labs.
DrMR: I’m curious about your thoughts on how I look at testing. Sometimes I feel I’m getting pulled over to the dark side of not really doing much testing at all. I come from a background where I myself had a parasite identified via testing when I was a patient. But I also consider myself a pretty science-based and evidence-based provider. I’m starting to really question how helpful many of these tests are.
Let me try to get this rationale out, and then I’m hoping you can maybe pull me back and prevent me from going over the event horizon into not testing at all. Many of the treatments that we have available, especially in natural medicine, don’t necessarily require … and this is my opinion, so you may not agree with it, but here’s how I’m thinking about it, … testing to guide them.
Various types of dysbiosis, even some infections, have been shown to be cleared by probiotics. We had the Gary Mullins study showing that herbal microbials can be about as effective as Rifaximin for SIBO (Small Intestine Bacterial Overgrowth). Then there’s also this observation that in some people, and I’ve published at least two case studies in our clinician’s newsletter about this, will do a pre/post-test. There have clearly been cases where the second test looks worse, but the patient’s symptoms are gone.
Do Tests Work?
I am formulating this hypothesis that the tests may not be that predictive for telling us how or when to treat a patient. But if we can start treating a patient with the available therapies, and continue to work them through a treatment algorithm, we can get most of these patients to a point where they don’t have symptoms.
I know one of the typical lines of thinking is, “Well, I have a chronically ill practice and I see really tough patients.” Which I totally understand, but I do, too. Even in that subset of patients, perhaps even more so in that subset of patients, sometimes I’m looking to other therapies that are not so much going after infections or dysbiosis but going after the immune system and trying to quell an overzealous immune system.
I don’t mean to be overly verbose here with this narrative, but I picture a patient listening to this who’s feeling really terrible and saying, “I’ll do anything to feel better. I’ll run all the tests I need to; I’ll use my financial resources.” I think we can make a pretty strong case that often we just treat someone empirically and that will get us to the resolution that the patient is looking for. Maybe that’s a bit heretical of a line of thinking, but I’m wondering what you agree with, what you disagree with, what you would modify.
DrAH: Okay, that’s a lot.
DrMR: A lot there, I know.
Our World is a Different Place
DrAH: I could talk through the hour for that one. Our world is really different than it was 30 years ago and that’s what I’ll say about the gut. I think there are a lot of things that we can do to help support the gut, but I do feel that the onslaught of toxins that are happening in our environment right now are wreaking havoc on our gut.
Our gut is our internal line of defense against the outside world. I cannot remember the name of the guy, but one of the guys who runs the GI-MAP test has said, “If you eat lettuce, you’re going to get exposed to parasites.” Why now are we seeing all these people who have these parasitic infections? It’s because we also have glyphosate and other chemicals that are being put on our food, in our water supplies, which are becoming much more toxic. We’re being much more exposed to heavy metals, not only through increased vaccine use but also in the air.
Here in Portland, Oregon, we had three different glass factories that got in major trouble three years ago. There was testing all the lichen growing on the trees and they’re realizing there’s a humongous amount of cadmium and lead and other toxins that people are breathing in. I always remember from medical school, we talked about your old grandpa. He used to drink whiskey and smoke cigars every day and he lived until he was 90. That just doesn’t happen anymore.
We have too much of an immune burden happening and these toxins decrease the immune system’s capability of fighting off infections.
That’s really what I’m saying. I’m not just giving people lots of anti-parasitic medications and anti-microbial medications, but we have to do a lot of detoxification because there are a lot of things that are we being exposed to that can’t get out of the body naturally, especially heavy metals and mycotoxins.
When I talk about treating mycotoxins, which are the toxins that are from molds, I talk about it like chelation. Our body does not just naturally get rid of these things. We have to bind the toxins up and get them out of the system. Not everybody grew up eating glutathione. That’s one of the main (supplements) we give. Herbs high in glutathione or plants that have a lot of glutathione. We have to do that manually.
I do think that our world is really different in terms of the infections we are being exposed to. They are much more highly likely to create major issues. I treat a lot of families, so I’ll see this a lot with kids who have PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).
Strep Infections in Kids
These kids have strep in their gut, in their tonsils, in their throat, in their sinuses and their body is freaking out about it. Their nervous systems and their immune systems do not like this and it actually creates neuropsychiatric issues. They have a lot of issues with anger and behavior. They also have issues that are more PT (physical therapy) or OT (occupational therapy) issues where they have dysgraphia. They cannot see properly. There’s a lot of chronic crossover between neurological development and psychiatric issues with these kids, and it’s because they have a high strep burden.
What’s fascinating to me is people will bring their kids in, especially moms. I mostly see moms. About 10 percent of my practice is dads that have been dragged in by their wives. The rest is the wives dragging their kids and husbands in. We do gut testing on (the kids), and they have huge, huge amounts of strep in their guts. But, guess what? So do their moms, but the moms don’t have these issues. All I can think is it’s because the kids are growing up in a much more toxic burden environment and they really can’t fight this stuff off. They don’t have as much of an immune system to begin with. They are going to be much more affected by these particular bacteria. Those are my thoughts. That’s just what I’ve seen. I think it’s fascinating.
DrMR: Sure. I agree with all that. I guess the one question I’m mulling over in my mind is would the test results allow you to be demonstrably more effective in how you treat that child or is there enough overlap in how you address these things where the testing doesn’t vastly change how you treat one individual compared to another based upon different lab findings?
DrAH: So that’s a great question. This is what I tell my patients. We really do not have a good way of looking at the gut. I mean, even whether it’s a parasitologist or whether we’re looking at DNA testing, immune testing, we can do secretory IgA for toxoplasma or other things.
The immune system testing is woefully inaccurate, because our immune system is not working that well, so it’s not going to show up, right? The two other tests I recommend, unfortunately, really depend on the sample that you’re getting that day.
You had mentioned that sometimes you treat people and then you retest them, and things look worse. One of the big things that’s a problem is the fact that a lot of these bacteria and parasites create biofilms. I always think about biofilms a bit going to Burning Man and seeing the tents that pop up, the camp tents in the desert. That’s what the bacteria are doing in the gut. They’re really trying to hide from your immune system so they’re not being seen. They basically create this mucosal tent, and that’s where they reproduce. Then they send off a little bubble tent with their kids to go inhabit another part of your intestine to try and take over.
One of the things with heavy metal chelation, we’ll do heavy metal testing on people and then we’ll do chelation. Then sometimes their heavy metal tests come back as worse. Because once we start chelating, we’re bringing all the metals out of the bones and out of the tissues, so it actually looks higher. It’s the same thing with when we’re doing the parasite treatments. As we’re breaking down biofilms and trying to kill things off and get things out of the gut. If we retest, it will look higher. It’s not necessarily higher. It’s just that we’ve been able to scrape off the first couple of layers. Then we’re able to see, there’s this other whole layer with these other things that are coming up and showing up in the gut.
DrMR: Right, right. That’s one fascinating hypothesis, and it parallels another. I haven’t heard as much of this hypothesis lately, I think it was originally pioneered by Timmins who has a bio-health lab taken up by Kailash, which was crypt hyperplasia, where these indentations, I guess you could picture in the intestinal tract with chronic infection and inflammation, your villi get shorter, and the crypts get deeper and some of these things can fester down there. There are definitely theories that are appealing, but then there’s also a counter-theory that can be put forward, which is, and this I think is somewhat well documented with the DNA tests, specifically, is that they suffer from false positives.
That’s the other thing that I’m always going back and forth on. That’s why it makes it more difficult for me when I’m seeing some of these cases where I’m like, “Wow, look at this retest, there’s a pathogen all of a sudden, but all this patient’s symptoms have been gone, and they’ve been gone for a number of weeks.” I think we need some eager young doctors to start studies to tell us which one of these holds more water.
Tests Give Clinicians a Starting Point
DrAH: One thing I will say that is interesting, I don’t tell people that it’s highly accurate, but what we do know is we always have something to work off of. I do see correlations. As I said, I treat moms, dads, and kids, and sometimes I’ll even use different testing methods. I just recently had a family where all three kids have PANDAS, there’s a two-year-old, 10-year-old and a 13-year-old. The two older kids I did a GI-MAP with and the one younger one I did a doctor’s data, just a GI microbiology because the parasite testing for younger kids is not quite as accurate. They all three had the exact same things. I was like, “Okay, there’s something here.”
One of them is mass spectrometry, that’s the doctor’s data, and the GI-MAP is PCR DNA. The more I see, the more I’m like: “Okay, I do think that it might not be 100 percent accurate, but I do think that it gives us the information that makes sense to me.” It’s going to make sense to me that all three kids were not C-sections. They were all vaginal births. They’re all going to get the same inoculation from the mom. They all had very similar pictures, even though they were two different tests that we used. I thought that was interesting.
DrMR: Yeah, it’s very interesting. Two thoughts popped into my mind. One, if you’re looking for information to support a given hypothesis, you can find it. Right? I’m mulling over the hypothesis that this testing may be prone to false positives and finding information to support that. I don’t want to speak on your behalf, but you’re presuming these tests hold a high amount of clinical validity and I don’t disagree with that. I’m just saying that’s the hypothesis I think you’re operating under and you’re finding data points to support that, which is why I think it’s going to be exciting to see, as natural medicine continues to evolve and we have studies that start to try to isolate for these variables and answer these questions, I think natural medicine is going to go from good to great as we really dial in these unanswered questions.
DrAH: I agree. I wish that there was something already out there, but I do think that we’re getting to it. Even PCR testing has become much larger in the last five years than it ever has been.
DrMR: Agreed. I’m struggling here, because we’ve only got about 20 minutes left. My podcast schedule is booked tighter than I’d like it to be. I’m looking at the clock going, “Darn, we have 20 minutes.” I want to get to some parasites in more detail, but I don’t want to shortchange MCAS. Can we do a primer on each? This is a guiding question, but two tests that you like — Parawellness Research and GI-MAP. Are there any insights that either clinicians or patients should be aware of when they get the test? One would want to look at it and be able to interpret it. Are there any pearls there and then any pearls regarding how to treat what you find? Again, a lot there and I’m asking you really hard questions and asking for a quick answer.
Some Talk About Parawellness Research
DrAH: Exactly, quick answer. First, the Parawellness test, anything that shows up on his tests I go ahead and treat. The parasitologist that runs that lab is amazing, and he finds things where nobody else has been able to find or none of the other labs come up as positive. He’s not looking at gram-negative bacterial infections. He’s just looking at parasites and yeast. In the state of Oregon as a naturopath, I’m a primary care provider, I can prescribe medications. Often I’ll just go ahead and do medications with that, especially because here in Oregon, we’ve got Cryptosporidium and Giardia in our watershed right now. A lot of people are coming up as positive for that and are having symptoms of chronic abdominal tenderness, pain, bloating, gas, things that are more of a parasitological nature.
DrMR: Right there, on that with treatment, are you finding Alinia to be one of the more effective anti-parasitics? Is there a handful that you’re looking to predominantly?
DrAH: Alinia is one of my favorites because we can give it to women who are pregnant. Not that I’m treating a lot of pregnant women but if a woman is trying to get pregnant, and we know that we want to get her gut in optimal health prior to having a child, I’m not afraid to give her Alinia. If she gets pregnant, then we’re just, “Okay, well, let’s just stop the treatment.” I’m not going to worry about the Alinia being teratogenic or anything like that.
That’s one of my favorites. It’s also a biofilm breaker. It’s also had a lot of studies done on it. It’s been used for H. pylori. I found one study that found it to be helpful in Parkinsons. I’m sure there’s a couple of other studies that show it to be anti-viral. It’s an interesting medication; it has a lot of potential.
Like Rifaximin, it’s not really your typical antibiotic. It increases lactobacillus in the gut. That’s not normal for an antibiotic.
DrMR: Yeah. Very cool.
DrAH: I do like Alinia a lot. I use Paramyosin for any entamoebas. I’ll use Albendazole and Mebendazole a lot for worms or suspected worms. Those are probably the three that I use most frequently, and then I’ll use other ones for any other oddball things that come up.
More Info on GI-MAP
DrMR: Got you. Then you were about to comment on the GI-MAP.
DrAH: Just with the GI-MAP, a lot of the infections are gram-negative or gram-positive infections. It really gives you a good overview of how off someone’s gut really is. So if they have a whole bunch of gram-negative bacteria showing up, it’s not necessarily that I’m going to treat a lot of those bacteria differently. A lot of them we treat similarly with berberine and garlic and neem and things that. I think it gives you a good overview for how messed up someone’s gut really is and just to know how hard you need to work at that. I think it’s a great tool to be able to use because often we think people end up getting parasitic infections because they started off life having a gut that has too many infections in it already and it’s very dysbiotic already.
DrMR: Sure. With probiotics, is this something that you’re using to help with dysbiosis, gram-negative bacteria, presumed dysbiosis, immune activation or any other capacity?
DrAH: Yeah, absolutely. I think I’m still a little bit old school. I know there’s some new acidophilus supplements coming out there or bacteria that’s coming out. I’m still a little bit old school because I want to kill something off and then supplement with lactobacillus.
Or we use megaspore or Saccharomyces boulardii to really help as we’re killing off some of the bacteria to help replace it. It’s something like when you tear a house down or anytime there’s a wildfire, there’s going to be a new plant you want to stick in there. The earth always wants to cover herself. Same thing with the gut, right? I always want to make sure that’s a part of the protocol.
DrMR: Got you. Before we leave the gut realm, anything else that you think is worth mentioning?
DrAH: Well, if you want to segue into mast cell …
DrMR: Thank you for doing my job for me, this is great.
The Immune System and Mast Cells
DrAH: One of the things that is interesting is that what happens is, when you have parasitic or bacterial infections, it down-regulates the Th1 system in the gut and up-regulates the Th2 system in the gut. There are three arms of the immune system: Th1, Th2, and Th17. Th1 is innate and Th2 is something that gets up-regulated with allergy and food intolerance. Sometimes for people what a parasitic infection is going to look is not necessarily: “I went to Mexico and I got sick and I haven’t been well, since.” It’s going to look like food allergies that keep getting worse, and that people can only eat one thing for a week, and then they have to shift on to the next protein that they can eat or the next vegetable that they can eat.
It shifts the whole immune system in the gut and how it works. If that’s left on its own for a long time and nobody treats it, that’s when I think we start getting the mast cell activation syndrome because the histamine response and the Th2 response just goes a little crazy because it’s just so tired of being irritated all the time. For me, it’s how they go together.
DrMR: I think it’s a great point and one that’s just worth briefly repeating, which is much of this immune system reactivity does seem to be driven by the gut. That’s why I think in the clinic, I’ve had fairly good results with histamine intolerance or Mast Cell Activation Syndrome because the gut is so powerful in driving that. Then there are some patients who can’t tolerate much of anything in terms of gut therapies.
What seems to be the shift in the algorithm for these cases is first we’re going to go to work with some mast cell stabilizers to help calm down the reactivity of your immune system. Then that can allow us to treat your gut more effectively. Or if you’re also suspecting that some of that mast cell activation, that immune hyper-excitability, is being driven by mold, then you could treat the mold. Is that bird’s eye view how you’re navigating this?
DrAH: Yeah, absolutely. More often than not that I’m treating mold before anything else. Because mold is such a trigger for people, I don’t want to give them Alinia or a whole bunch of anti-parasitic treatments because it will actually drive the mast cell dysfunction and make it worse.
DrMR: Sorry. Really quickly. I think it’s worth repeating to make sure that clinicians grab this. If you see a patient whose treatment history is littered with reactivity, then you may just want to put on pause any further treatments other than either MCAS or mold because that may be the hinge that’s preventing them from tolerating any further treatments.
DrAH: Correct. That’s very, very common. I think our understanding of mold is new for our patient populations. I remember when I first got into it, there were some people I’d been seeing for years that I was suddenly like, “Oh my God, I think you have mold.” It took me so long to figure this out, and now I feel like I’m much more attuned to it and can get it much quicker with my patient population. When I first started, I did not know all the things to look for.
DrMR: With testing for MCAS, I’ve come to a point now where I’m not really concerned about definitively diagnosing MCAS. We do have a Lawrence Afrin-inspired quiz that we send our patients. It’s a symptomatic inventory, and the different symptoms score differently. We’re trying to objectify this to some extent, but I’m not overly concerned about diagnosing the MCAS. For me, it’s more of a presumption based upon presentation.
DrMR: It’s the diagnosis of the mycotoxins that I would like to be able to see mainly to identify if this does seem to accompany patients who are very reactive? Also, you can monitor progress. Do you have a test that you like, and can you tell us more about how you’re testing and maybe retesting as you track a patient?
DrAH: I have four minutes, right?
DrMR: Well, I mean, we’re going to irritate the person who I was supposed to talk with soon, but I’d say we can go max another 15. I’ll let you know when I definitely have to go.
There’s More to Mold Than You Think
DrAH: That’s fine. Just really quick, it’s the exact same thing as with parasite testing. If it’s for mold testing, there is not a good test. Literally, we have two tests. We’ve got Real Time Labs just on mycotoxin tests. This is just on the body, so it’s a urine test. Then we have Great Plains Labs that does a urinary mycotoxin, it’s called Mycotox Lab. They’re both a little bit different technology. One of the big mold gurus that a lot of us follow is Neil Nathan. He’s an MD in California. He wants to run both of those tests on his patients because he thinks you’re going to be able to get a positive if you run both of them. They’re both testing for different things. They’re both $300 out of pocket. That’s highly unlikely in my patient population. I see a lot of patients who have insurance and can’t spend $600 on lab tests.
A lot of times, it’s more looking really closely at the clinical picture. Then, if they have had any history of being in a moldy apartment, or being in a moldy house, or having a moldy car, or having a moldy washer … a lot of these front-loading washers, if you look at the rubber rim, there’s mold growing in it and that can be affecting someone’s health pretty severely. A lot of times I’ll hook it up clinically and if I really feel this is probably what’s going on for them, I don’t want them to spend their hard-earned money on a lab test that I don’t know if it’s going to come out as positive or not because I’m already pretty clinically suspicious that this is what’s going on for them.
Testing for Mold in Your Home
What’s more important to me is, are they in a place that’s safe? Are they in a home that still has mold in it? Because 99 percent of the time you’ll ask them, do you suspect that you have any mold in your home? Do you ever smell any mold or must in your house? “No.” Every time it’s no, no, no, and then usually by the fourth or the fifth appointment that I’m asking them then they’re like, “I actually just cleaned out underneath my basement sink and what do you know? There was some mold there. Or I moved a cardboard box from the attic and I found mold on it.” Usually, I want to just make sure because I want them to do that anyway, even if they did do the urine test to show, “You’ve got mold in your system.” I want to make sure that they’re in a house that’s clean and clear.
The home testing is a whole other ball of wax, but typically I’m recommending that people do the ERMI test at least to get started. That you can either get through Mycometrics Labs or EnviroBiomics Labs. They send you a little Swiffer and then they want you to take samples, not from very dusty places. Not from underneath the refrigerator that never gets dusted. They want you to take dust samples from on top of the piano or all the places where you live and probably get dusted maybe every month or three months. If you live in my house and you have two kids, then you can’t bother dusting. That’ll at least tell us if people are in an environment that has any mold that is suspicious.
DrMR: There are also these … I think they’re called agar plates. Where you just put a petri dish on a surface. I’ve heard some people like those because instead of testing for a certain strain, you can culture and then have a lab analyze. Do you feel there’s been merit to that assessment?
DrAH: Here’s where I use those, and I think they’re good and that the lab that does that is Immunolytics. I use that for if people know they’re in a moldy situation, and they want to test their furniture. You can do what’s called a TAP Test, where you open up the top of the agar plate, and you tap it against any soft furniture that you have to see if that has any mold growing in it. The other place that it’s really handy to utilize this is if your car has any smells in it or you think you might have had any leaks in your car. Not as handy for leather seats, but you can certainly use it for the floors and things like that to see if you have actual mold growing in your car, or if that’s a part of your source of infection.
I don’t feel it’s as helpful for rooms in a house, just because the rooms are so large. And I think they only have you open it for an hour. You’re really not getting a full spectrum of what are you breathing in on a daily basis. Whereas the Swiffer cloths with the ERMI testing, if you’re getting areas that the dust has been collecting for a couple of weeks, I think you’re going to get a much more accurate representation of what you’re actually breathing in every day. Does that make sense?
DrMR: Got you. Yeah, that makes sense. As you said, the home testing does seem to be a ball of wax, which is why I always encourage clinicians and providers not to look at lab testing results as the end all be all and something to look at literally.
With treatment, essentially, various binders can be used, we don’t necessarily have to go into detail of all the different binders. If someone is really sensitive, we’re going to support their immune system and the reactivity with MCAS agents to get them a little more calmed down and less reactive, and then once they’re ready, we’ll initiate binding therapy.
DrMR: Here’s a good question. With treatment, are you liking retesting at maybe two- or three-month intervals or are you using one’s symptoms as your primary barometer?
Treating Mold Infections
DrAH: For mold, I’m using symptoms as a barometer, again because the urinary mycotoxin testing is an out-of-pocket expense. If people are feeling better, I don’t worry about retesting and I just know that with metal chelation, it takes a long time for people to chelate and get the mold out of their system. I usually tell people, we’re probably looking at, at least six months to a year once you’re in a non-moldy environment for getting this stuff out of your system.
Most people, if they’re really diligent and get into a clean environment, will start feeling better within three months. As long as they’re feeling good, then I know we’re on the right track and then I usually rotate through binders. My favorite is Liposomal Glutathione, but some people just cannot stand the taste of Glutathione. Some people will do NaTHNAC or Silymarin, which is the milk thistle extract or Acetyl Glutathione. These are things that I’ll give people who I know have mold.
DrMR: What was that second one again? I haven’t heard that one before. Silymarin?
DrAH: Yes, Silymarin. It’s the extract from milk thistle and it basically gives the body glutathione.
DrMR: If people don’t like Glutathione, you give them the Silymarin instead?
DrAH: It’s in a capsule and it doesn’t have the same sulfury taste. If people are really sick, then I encourage them to do the liposomal, because one of the things we know about mold is it actually depletes glutathione and it depletes our body’s ability to detoxify.
DrMR: You’re finding that about three months is when someone is typically noticing improvement, maybe not necessarily fully recovered, but is that your first key? “Okay, we’re on the right track. If by the third month-ish, they’re starting to notice improvements.”
DrAH: Well, it’s always a rough start, because it usually takes a long time for people to figure out what their environment is and if there’s mold in the environment. I do have one patient who I’ve been seeing for years and he had a leak in his apartment. He pretty much got out of his apartment right away. He started having headaches when he would get home from work. He would get headaches at home, he was having sinus issues, and I was just like, “I think you might have some mold.” He’s like, “Okay, I’m out of there.” He was really a very compliant patient. It was an apartment, which is easier to get out of in some ways because it’s not something you own. He was like, “I’m out of there.”
This is somebody who was super compliant, who did everything I asked him to do and got out of the house and within three months he was feeling way better. That is not so easy when you have people with mold illness and they own their homes. This is their safe place. This is your house. This is where you raise your kids, where you have your family, where you have your Christmases and your Hanukkahs and everything. It’s such a hard thing to diagnose people and have them try to figure out what’s going on. Like, “Is it a safe place for them or not?” It usually takes people a while to get to that point.
I almost hate putting a timeline on it because everybody’s situation is so different. What I would say is, that’s where I feel people will start feeling better, within that first three months. If we know that they’re out of an environment and if we’re detoxing them and if they’re taking their binders.
The other issue with binders, is they bind everything. So a lot of times, especially if they have MCAS as well, and they’re taking 10 things a day, the binder has to be taken a couple of hours away from everything else. Usually, they have to end up putting a timer on their phone. A lot of people don’t start the binders until I have to talk to them over and over again. That’s the most important thing for you to take right now is your binder because that’s cleaning the mycotoxins out.
Sometimes it takes people a while to get up to speed with that. The big thing about mold, too, is people have a lot of brain fog, and they’ve got what I would diagnose as toxic encephalopathy because they have exposure and they have got a lot of brain inflammation. Their brains are not working well. It makes it harder for them to think through their daily routines, to think, “Oh my God, I’ve got to hire a mold inspector for my house. I have to get rid of all my paperwork.” Anything that they have to do to help with the mediation process. It just becomes that much harder when you have a toxic brain.
- Assess environment and address this – very important
- Use symptoms to guide treatment
- Using binders in combination with antimicrobials helps
- 3 months is when most people will notice improvements
- May take up to 6 months
DrMR: The gut-brain connection, and I guess the immune-brain connection. No matter how you get there, it’s unpleasant when you’re suffering from those symptoms.
DrMR: This has been a fantastic conversation. We got a lot packed in to maybe 45 minutes or so. I’m proud of us. Do you have a website or anywhere else that you’d refer people if they wanted to track you down?
DrAH: Yeah, I’m at AnneHillND.com. That’s my teaching website and you can reach me there. Then also the place where I practice out of is called alderfamilymedicine.com. That’s all just one big one word. We’re trying to teach providers in our area about mold and infections and lime and all the other fun things that we encounter in our practice. If anybody’s interested in classes, keep in touch.
DrMR: Do you also offer telehealth or distance visits?
DrAH: Yes. Another provider and I at my practice do. We also have people come into town to see us all the time.
DrMR: Great. Awesome. Well, Anne, thank you so much for taking the time. It’s been a great conversation.
DrAH: Great, thanks. Great to talk to you.
What do you think? I would like to hear your thoughts or experience with this.
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